Between January 1979 and December 1993, 143 out of 10,263 (1.4%) patients at the Wayne State University/Detroit Medical Center who underwent cardiac surgery developed sternal dehiscence with or without mediastinitis. After mediastinal drainage and sternal debridement, early wound closure was obtained with utilization of several muscle flaps, either pectoralis major or rectus abdominus alone, or in combination. However, in between these two stages of operative treatment, massive hemorrhage occurred in seven patients (0.07%) from a tear of the anterior wall of the right ventricle, resulting from traction produced when dense adhesions form between the under surface of the open sternum and the right ventricular anterior wall. With temporizing resuscitation and immediate operative repair of the right ventricular rupture, six out of the seven patients survived, with subsequent sternal wound closure using muscle flaps. To avoid the complication of spontaneous right ventricular rupture following sternal dehiscence, the lessons learned from this experience mandates that the right ventricle must always be dissected free from the sternal edges during the initial operative debridement, making this horrendous complication hopefully preventable.